LCD Reference Article Billing and Coding Article

Billing and Coding: Billing Medicare for the SphenoCath® and Other Similar Devices

A55584

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A55584
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Billing Medicare for the SphenoCath® and Other Similar Devices
Article Type
Billing and Coding
Original Effective Date
01/01/2017
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

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Article Guidance

Article Text

Noridian is issuing coding guidance for billing the use of Dolor Technologies SphenoCath® device or other similar delivery devices. To bill for use of these devices use CPT® 64999 as described in CPT Assistant (July 2014. Volume 24, Issue 7, pages 8-9).

Source:

Internet Only Manual, CMS Pub 100-4 - Medicare Claims Processing Manual, Chapter 12 - Physicians/Nonphysicians Practitioners, Section 50.K:

"If the physician performing the medical or surgical procedure also provides the level of anesthesia lower in intensity than moderate sedation, such as a local or topical anesthesia, then the moderate sedation code should not be reported and no separate payment should be allowed by the A/B MAC (B)."

 

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

To bill for this service, enter 64999 in the comment field as listed below with the description SphenoCath® or the name of the delivery device used.

For Part A:

  • 2300 loop. NTE segment for the electronic claim
  • Form Locator 80 Remarks on the UB04 form

Part B:

  • Loop 2400/SV101-7 for the electronic claim or
  • Item 19 on the CMS-1500 paper claim form

Do not use CPT® 64400 and/or 64505 to bill for this device.

 

Group 1 Codes
Code Description
64999 UNLISTED PROCEDURE, NERVOUS SYSTEM
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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
999x Not Applicable
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
99999 Not Applicable
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2023 R6

Updated to indicate this article is not an LCD Reference Article.

01/01/2023 R5

Per 2023 CPT/HCPCS updates, either the long or short description of CPT code 64999 has been updated. 

04/29/2020 R4

Converted to a Billing and Coding article and added 64999 to the CPT/HCPCS Codes section. No change in coverage was made.

01/01/2017 R3

Article converted to Billing and Coding. No changes to coverage were made.

01/01/2017 R2

Updated the Article Title, Text and Group 1 Paragraph to allow for other approved delivery devices used for Sphenopalatine Ganglion Blocks and updated the IOM Source and quotation in the Article Text.

01/01/2017 R1

CPT® code 64550 changed to 64505 in Paragraph 1 of the CPT/HCPCS Code Section due to typographical error.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
11/08/2023 01/01/2023 - N/A Currently in Effect You are here
12/16/2022 01/01/2023 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • SphenoCath®
  • Sphenopalatine
  • 64400
  • 64505
  • 64999